Value-based Care

Of the $3 trillion spent annually on healthcare in the United States, an estimated 10-30% of health spending consists of low-value care, or patient care with no net benefit to patients in specific clinical scenarios. Moreover, many of these health services can directly harm patients through side effects and complications.

Our team has recently been awarded a KL2 career development award (Dr. John Mafi) from the UCLA CTSI (UL1TR001881, PI: Dr. Steven M. Dubinett) and an innovation award (Drs. John Mafi, Folsade May and Catherine Sarkisian) from the Robert Wood Johnson Foundation and MacColl Institute (Grant # 73506) to measure and reduce low-value care at UCLA. Drs. Mafi and Sarkisian have been fortunate to find like-minded partners, co-investigator Folasade P. May, MD, PhD, MPhil and Division Chief Eric Esrailian, MD, MPH, who are passionate about improving quality and value in the UCLA Vatche and Tamar Manoukian Division of Digestive Diseases. Also key to endeavor is a multidisciplinary team from UCLA and RAND, including Cheryl Damberg, PhD, Bob Brook, MD, ScD, Reshma Gupta, MD, MSPH, Sam Skootsky, MD, and several others on how to measure and reduce low-value care. Specifically, we are leveraging the rich clinical data from the electronic health record, including natural language processing, in order to develop with highly valid and reliable “eMeasures” of low-value care.

• We are evaluating several conditions for potential value measure development, such as low-value endoscopy for uncomplicated heartburn or dyspepsia or low-value colonoscopy for cancer screening for patients under age 50 without family history or other risk factors.
• Next, we hope to present these measures to various practices across UCLA Health System in an effort to educate and engage frontline clinicians, provide customized performance feedback, and ultimately evaluate the impact on reducing low-value care.
• Such a pilot initiative will be the first of its kind, and we hope it will serve as a new standard to measure and improve value in the United States.
• Ultimately, we hope this work will catalyze a broader movement to tackle low-value care both locally and nationally.
• Newsletter article
   

John N. Mafi, MD, MPH

Folasade P. May, MD, PhD, MPhil

Catherine Sarkisian, MD, MSPH 

Dr. Mafi’s research focuses on quality measurement and improvement and how electronic health records can influence the value of care. He has led several national studies assessing the epidemiological trends and predictors of potentially harmful or “low-value care.”

Dr. May is involved in several prevention-focused intervention studies to improve the delivery and quality of colon cancer screening to veterans and other underserved populations

Dr. Sarkisian conducts research on the problem of disability among underserved older adults. She is particularly focused on geriatric frailty and the role of older adults' expectations for aging on health behaviors such as physical activity.